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Jin X, Ding Y, Weng Q, Sun C, Liu D, Min J. Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury. Esophagus 2024:10.1007/s10388-024-01061-z. [PMID: 39020058 DOI: 10.1007/s10388-024-01061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/25/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Assessment of the effect of continuous cuff pressure control on airway injury in middle-aged and elderly patients undergoing endoscopic submucosal dissection (ESD). METHOD A total of 104 eligible middle-aged and elderly patients requiring esophageal ESD from July 2022-September 2023 at the First Affiliated Hospital of Nanchang University were selected and randomly divided into two groups: the group undergoing general anesthesia tracheal intubation with continuous control of cuff pressure after intubation (Group A, n = 51) and the group undergoing general anesthesia tracheal intubation with continuous monitoring without control of cuff pressure (Group B, n = 53). After endotracheal intubation in Group A, under the guidance of an automatic cuff pressure controller, the air was used to inflate the tracheal cuff until the cuff pressure was 25-30cmH2O. The cuff pressure after intubation was recorded, and then the cuff pressure parameters were directly adjusted in the range of 25-30cmH2O until tracheal extubation after the operation. After endotracheal intubation, patients in Group B inflated the tracheal cuff with clinical experience, then monitored and recorded the cuff pressure with a handheld cuff manometer and instructed the cuff not to be loosened after being connected to the handheld cuff manometer-continuous monitoring until the tracheal extubation, but without any cuff pressure regulation. The patients of the two groups performed esophageal ESD. The left recumbent position was taken before the operation, and the cuff's pressure was recorded. Then, insert the gastrointestinal endoscope to find the lesion site and perform appropriate CO2 inflation to display the diseased esophageal wall for surgical operation fully. After determining the location, the cuff pressure of the two groups was recorded when the cuff pressure was stable. After the operation, the upper gastrointestinal endoscope was removed and the cuff pressure of the two groups was recorded. Postoperative airway injury assessment was performed in both groups, and the incidence of sore throat, hoarseness, cough, and blood in sputum was recorded. The incidence of postoperative airway mucosal injury was also observed and recorded in both groups: typical, episodic congestion spots and patchy local congestion. RESULT The incidence of normal airway mucosa in Group A was higher than that in Group B (P < 0.05). In comparison, the incidence of occasional hyperemia and local plaque congestion in Group A was lower than in Group B (P < 0.05). CONCLUSION Continuous cuff pressure control during operation can reduce airway injury in patients with esophageal ESD and accelerate their early recovery after the operation.
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Affiliation(s)
- Xianwei Jin
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Yuewen Ding
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Qiaoling Weng
- Department of Anesthesiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chumiao Sun
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Dongbo Liu
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Jia Min
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China.
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Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy. J Clin Anesth 2016; 36:118-122. [PMID: 28183547 DOI: 10.1016/j.jclinane.2016.10.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/27/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of postoperative dexmedetomidine infusion on sleep quality in patients undergoing abdominal hysterectomy. DESIGN Randomized, double-blind study. SETTING Postoperative recovery area and ward. PATIENTS Sixty patients of American Society of Anesthesiologists physical status I or II scheduled for elective hysterectomy were enrolled. INTERVENTIONS Patients in group C received sufentanil infusion (a continuous dosage of 0.02 μg kg-1 h-1, a bolus dose of 0.02 μg/kg, a 10-minute lockout interval), and patients in group D received combined infusion of sufentanil with dexmedetomidine (a continuous dosage of sufentanil 0.02 μg kg-1 h-1 with dexmedetomidine 0.05 μg kg-1 h-1, a bolus doses of sufentanil 0.02 μg/kg with dexmedetomidine 0.05 μg/kg, a 10-minute lockout interval). MEASUREMENTS Polysomnography (PSG) was performed on the following 3 nights: the night before surgery (PSG1), the first night after surgery (PSG2), and the second night after surgery (PSG3). Postoperative pain scores using visual analog scoring scale, levels of sedation, and cumulative sufentanil consumptions were also recorded. RESULTS After surgery, patients suffered from significant sleep disturbance with a lower sleep efficiency index and subjective sleep quality and a higher arousal index at PSG2 and PSG3. Compared with group C, postoperative administration of dexmedetomidine significantly improved the sleep efficiency index and subjective sleep quality. Although the rapid eye movement and N3 stage sleep did not differ between the 2 groups, the N1 stage and arousal index were lower and the N2 stage in group D at PSG2 and PSG3 was higher. Compared with group C, patients in group D have better pain relief with a lower visual analog scoring scale and cumulative sufentanil consumptions at 6, 24, and 48 hours after surgery. CONCLUSIONS Dexmedetomidine infusion not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing hysterectomy.
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Roizenblatt S, Souza AL, Palombini L, Godoy LM, Tufik S, Bittencourt LRA. Musculoskeletal Pain as a Marker of Health Quality. Findings from the Epidemiological Sleep Study among the Adult Population of São Paulo City. PLoS One 2015; 10:e0142726. [PMID: 26600201 PMCID: PMC4657923 DOI: 10.1371/journal.pone.0142726] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background We are witnessing the growth of urban populations, particularly in the developing world. São Paulo, the largest city in South America, continues to grow, and this growth is dramatically effecting the environment and human health. The aim of this study was to estimate the point prevalence of chronic pain in São Paulo city dwellers and to explore the influence of aspects related to urbanicity. Methods A two-stage cluster randomized sample included 1100 individuals of the city of Sao Paulo, representing the population proportionally in terms of gender, age and social classes in 2007. For this observational cross-sectional study, the household sample was interviewed using validated questionnaires for sociodemographic aspects, the Beck inventories for anxiety and depression, the WHOQoL-REF for quality of life, the Chalder Fatigue Scale. Musculoskeletal pain was defined as diffuse pain or pain located in the back, joints or limbs. Data regarding sleep complaints and polysomnography were obtained from the Epidemiologic Sleep Study conducted in São Paulo city in 2007. Results The prevalence estimate of chronic musculoskeletal pain was approximately 27%, with a female/male ratio of approximately 2.6/1. The predictors were being in the age-range of 30–39 years, low socioeconomic and schooling levels, obesity, sedentarism, fatigue, non-restorative sleep, daytime sleepiness, poor sleep quality, poor life quality, anxiety and depression symptoms. Psychological wellbeing was the main discriminator between responders with chronic musculoskeletal pain and the controls, followed by depression for the participants with poor psychological wellbeing, and fatigue, for the remaining ones. Insomnia syndrome was the third-level discriminator for those with fatigue, whereas sleep quality for those without fatigue. Conclusions Musculoskeletal pain was frequently reported by São Paulo city dwellers and its correlates with psychological and sleep aspects are suggestive of a response to urbanicity. Trial Registration ClinicalTrials.gov NCT00596713
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Affiliation(s)
- Suely Roizenblatt
- Department of Internal Medicine, UNIFESP, São Paulo, Brazil
- * E-mail:
| | | | | | | | - Sergio Tufik
- Department of Psychobiology, UNIFESP, São Paulo, Brazil
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Lopez R, Jaussent I, Dauvilliers Y. Pain in Sleepwalking: A Clinical Enigma. Sleep 2015; 38:1693-8. [PMID: 25902807 DOI: 10.5665/sleep.5144] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. DESIGN Cross-sectional case-control study. SETTING Data were collected at the Sleep Disorders Center, Montpellier, France. PARTICIPANTS One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. MEASUREMENTS AND RESULTS Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. CONCLUSION Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation.
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Affiliation(s)
- Régis Lopez
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France
| | - Isabelle Jaussent
- Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France
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Gamma-Hydroxybutyrate (Sodium Oxybate): From the Initial Synthesis to the Treatment of Narcolepsy–Cataplexy and Beyond. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krenk L, Kehlet H, Bæk Hansen T, Solgaard S, Soballe K, Rasmussen LS. Cognitive Dysfunction After Fast-Track Hip and Knee Replacement. Anesth Analg 2014; 118:1034-40. [DOI: 10.1213/ane.0000000000000194] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Krenk L, Jennum P, Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement. J Clin Sleep Med 2014; 10:321-6. [PMID: 24634631 DOI: 10.5664/jcsm.3540] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days. METHODS Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual. RESULTS Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups. CONCLUSIONS Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals. CITATION Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
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Affiliation(s)
- Lene Krenk
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, and Centre for Healthy Ageing, Faculty of Health, University of Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark
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Bertin P, Taieb C. Semiological evaluation of pain according to its origin: a prospective, observational, and national study of current French medical practice. Curr Med Res Opin 2013; 29:653-9. [PMID: 23540435 DOI: 10.1185/03007995.2013.791264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine how the origin of acute pain influences its semiological characteristics, and to evaluate the efficacy and safety of two Level 2 analgesic combinations in general practice. RESEARCH DESIGN AND METHODS This prospective, observational, multicenter study enrolled patients who consulted general practitioners across France for intense pain that lasted ≥7 days and for which the physician prescribed paracetamol-codeine or paracetamol-tramadol. Completed physician (Day 0) and patient (Days 0-3 and Days 4-7) questionnaires provided data on the origin, characteristics, impact, and treatment of the pain, during the 7 days after the initial consultation. MAIN OUTCOME MEASURES Pain intensity (0-10 unidimensional numerical scale), type (SF-MPQ) and impact on quality of life (QoL; SF-12). RESULTS Overall, 1003 patient questionnaires were completed for Days 0-3 and 941 for Days 4-7. The origin of pain was most commonly disease or trauma. Mean baseline pain intensity was 7 (SD 1.3; 0-10 numerical rating scale), and was similar regardless of the origin. The time-course of pain differed according to its origin: more than two-thirds of patients with trauma/work accident related pain described it as being constant, whereas 43% of those with disease-related pain described it as recurrent/intermittent. The origin of pain also influenced its QoL impact: trauma/work accident related pain led to functional and/or professional temporary incapacity in 77% and 83% of patients (vs 63% for disease-related pain), while disease-related pain led to a change in mood and/or feeling of anxiety in 79% of patients (vs 47% [trauma] and 58% [work accident related]). Both paracetamol-codeine and paracetamol-tramadol reduced pain intensity by approximately 75% and were well tolerated. Key limitations relate to the observational study design, countered by advantages gained from the 'real life' evaluation of acute pain and its treatment in a general medical practice setting. CONCLUSIONS Acute pain should not be understood as a single entity but as multiple entities with specific characteristics related to its underlying origin. Furthermore, our data suggest that, as already demonstrated in clinical trials, Level 2 analgesia provides effective relief of acute pain in 'real life' conditions.
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A double-blinded randomized evaluation of alfentanil and morphine vs fentanyl: analgesia and sleep trial (DREAMFAST). Br J Anaesth 2013; 110:293-8. [DOI: 10.1093/bja/aes362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty. Br J Anaesth 2012; 109:769-75. [PMID: 22831887 DOI: 10.1093/bja/aes252] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement with length of stay (LOS) <3 days. The primary endpoint was REM sleep duration on the first postoperative night compared with before operation. METHODS Ten subjects (≥60 yr) receiving spinal anaesthesia and multimodal opioid-sparing postoperative analgesia for total hip or knee arthroplasty were included. Ambulatory polysomnography was performed one night before operation at home, continuously during hospitalization, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. RESULTS The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean of 18.2 (9.5-23.5)% of total sleep time to 1.2 (0-5.8)% on the first postoperative night (P=0.002); awake time increased from 19.1 (3.7-44.4)% to 44.3 (12.2-70.6)% (P=0.009); and sleep architecture on the first postoperative night was more disturbed than before operation. Sleep architecture normalized on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. CONCLUSIONS Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated on the first postoperative night after fast-track orthopaedic surgery but returned to pre-admission levels when at home on the fourth postoperative night.
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Affiliation(s)
- L Krenk
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Buprenorphine disrupts sleep and decreases adenosine concentrations in sleep-regulating brain regions of Sprague Dawley rat. Anesthesiology 2011; 115:743-53. [PMID: 21857500 DOI: 10.1097/aln.0b013e31822e9f85] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Buprenorphine, a partial μ-opioid receptor agonist and κ-opioid receptor antagonist, is an effective analgesic. The effects of buprenorphine on sleep have not been well characterized. This study tested the hypothesis that an antinociceptive dose of buprenorphine decreases sleep and decreases adenosine concentrations in regions of the basal forebrain and pontine brainstem that regulate sleep. METHODS Male Sprague Dawley rats were implanted with intravenous catheters and electrodes for recording states of wakefulness and sleep. Buprenorphine (1 mg/kg) was administered systemically via an indwelling catheter and sleep-wake states were recorded for 24 h. In additional rats, buprenorphine was delivered by microdialysis to the pontine reticular formation and substantia innominata of the basal forebrain while adenosine was simultaneously measured. RESULTS An antinociceptive dose of buprenorphine caused a significant increase in wakefulness (25.2%) and a decrease in nonrapid eye movement sleep (-22.1%) and rapid eye movement sleep (-3.1%). Buprenorphine also increased electroencephalographic delta power during nonrapid eye movement sleep. Coadministration of the sedative-hypnotic eszopiclone diminished the buprenorphine-induced decrease in sleep. Dialysis delivery of buprenorphine significantly decreased adenosine concentrations in the pontine reticular formation (-14.6%) and substantia innominata (-36.7%). Intravenous administration of buprenorphine significantly decreased (-20%) adenosine in the substantia innominata. CONCLUSIONS Buprenorphine significantly increased time spent awake, decreased nonrapid eye movement sleep, and increased latency to sleep onset. These disruptions in sleep architecture were mitigated by coadministration of the nonbenzodiazepine sedative-hypnotic eszopiclone. The buprenorphine-induced decrease in adenosine concentrations in basal forebrain and pontine reticular formation is consistent with the interpretation that decreasing adenosine in sleep-regulating brain regions is one mechanism by which opioids disrupt sleep.
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Dauvilliers Y, Bayard S, Shneerson JM, Plazzi G, Myers AJ, Garcia-Borreguero D. High pain frequency in narcolepsy with cataplexy. Sleep Med 2011; 12:572-7. [PMID: 21570344 DOI: 10.1016/j.sleep.2011.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/21/2010] [Accepted: 01/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Narcolepsy with cataplexy (NC) is caused by the loss of hypocretin neurons. Recent studies highlighted the roles for hypocretins in the modulation of nociceptive transmission. The aims of the present multicenter case-control study were to look at the frequency of pain in NC and to study the determinants and impact of pain on narcolepsy symptoms and quality of life (QoL). METHODS Sixty-seven adult patients with NC, together with their physician, partner/friend, and sex- and age-matched normal controls underwent a face-to-face interview and completed questionnaires on the presence and frequency of pain, narcolepsy symptoms and QoL (Short-Form 36-item score, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study, Fatigue Severity Scale, and Beck Depression Inventory). RESULTS One-third (32.8%) of NC patients experienced pain at least monthly, with a significantly higher frequency and impact than controls (17.9%) and independent of the patients' narcolepsy medication. The reporting of pain was well matched between patients and partners/friends but significant differences were observed between patients and physicians, with physicians significantly underestimating its frequency and impact. The location of chronic pain varies within subjects with differences between NC and controls. We pinpointed that sleep quantity and depression were determinants for pain, and chronic pain had significant impact on sleep quantity, depression and QoL in NC. CONCLUSION We report, for the first time, evidence that chronic pain is significantly more common and disabling in NC compared to the general population. The findings call for improved attention to assessment and treatment of pain in the follow-up of NC.
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Affiliation(s)
- Yves Dauvilliers
- Department of Neurology, Hôpital Gui de Chauliac, CHU Montpellier, National Reference Network for Orphan Diseases (Narcolepsy), Montpellier, France.
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